Health care work. Staying healthy is every health care professional's top on-the-job priority, but it ranks even higher when you're staying healthy for two. Among the potential risks you'll need to protect yourself and your baby from are exposure to chemicals (such as ethylene oxide and formaldehyde) used for sterilization of equipment; to some anticancer drugs; to infections, such as hepatitis B and AIDS; and to ionizing radiation (such as that used in diagnosis or treatment of disease). Most technicians working with low-dose diagnostic X-rays are not exposed to dangerous levels of radiation. It is recommended, however, that women of childbearing age working with higher-dose radiation wear a special device that keeps track of daily exposure, to ensure that cumulative annual exposure does not exceed safe levels. Staying healthy is every health care professional's top on-the-job priority, but it ranks even higher when you're staying healthy for two. Among the potential risks you'll need to protect yourself and your baby from are exposure to chemicals (such as ethylene oxide and formaldehyde) used for sterilization of equipment; to some anticancer drugs; to infections, such as hepatitis B and AIDS; and to ionizing radiation (such as that used in diagnosis or treatment of disease). Most technicians working with low-dose diagnostic X-rays are not exposed to dangerous levels of radiation. It is recommended, however, that women of childbearing age working with higher-dose radiation wear a special device that keeps track of daily exposure, to ensure that cumulative annual exposure does not exceed safe levels.

Depending on the particular risk you are exposed to, you might want to either take safety precautions as recommended by NIOSH (see box) or switch to safer work for now.

Manufacturing work. If you have a factory or manufacturing job that has you operating heavy or dangerous machinery, talk to your boss about a change of duties while you're pregnant. You can also contact the machinery's manufacturer (ask for the corporate medical director. for more information about the product's safety. How safe conditions are in a factory depends on what's being made in it and, to a certain extent, on how responsible and responsive the people who run it are. OSHA lists a number of substances that a pregnant woman should avoid on the job. Where proper safety protocols are implemented, exposure to such toxins can be avoided. Your union or other labor organization may be able to help you determine if you are properly protected. You can also get useful information from NIOSH or OSHA (see box, facing page). If you have a factory or manufacturing job that has you operating heavy or dangerous machinery, talk to your boss about a change of duties while you're pregnant. You can also contact the machinery's manufacturer (ask for the corporate medical director. for more information about the product's safety. How safe conditions are in a factory depends on what's being made in it and, to a certain extent, on how responsible and responsive the people who run it are. OSHA lists a number of substances that a pregnant woman should avoid on the job. Where proper safety protocols are implemented, exposure to such toxins can be avoided. Your union or other labor organization may be able to help you determine if you are properly protected. You can also get useful information from NIOSH or OSHA (see box, facing page).

Physically strenuous work. Work that involves heavy lifting, physical exertion, long hours, rotating shifts, or continuous standing may somewhat increase a woman's risk for preterm delivery. If you have such a job, you should request a transfer, by 20 to 28 weeks, to a less strenuous position until after delivery and postpartum recovery. (See Work that involves heavy lifting, physical exertion, long hours, rotating shifts, or continuous standing may somewhat increase a woman's risk for preterm delivery. If you have such a job, you should request a transfer, by 20 to 28 weeks, to a less strenuous position until after delivery and postpartum recovery. (See page 196 page 196 for recommendations on how long it is safe for you to stay at various strenuous jobs during your pregnancy.) for recommendations on how long it is safe for you to stay at various strenuous jobs during your pregnancy.) Emotionally stressful work. The extreme stress in some workplaces seems to take its toll on workers in general and on pregnant women in particular. So it makes sense to cut down on the stress in your life as much as possible, especially now. One obvious way to do that is to switch to a job that is less stressful or take early maternity leave. But these approaches aren't feasible for everyone; if the job is critical financially or professionally, you may find yourself even more stressed if you leave it. The extreme stress in some workplaces seems to take its toll on workers in general and on pregnant women in particular. So it makes sense to cut down on the stress in your life as much as possible, especially now. One obvious way to do that is to switch to a job that is less stressful or take early maternity leave. But these approaches aren't feasible for everyone; if the job is critical financially or professionally, you may find yourself even more stressed if you leave it.

You might, instead, consider ways of reducing stress, including meditation and deep breathing, regular exercise (to release those feel-good endorphins), and having more fun (seeing a movie instead of working until 10 P.M P.M.). Talking to your employer, explaining that overtime, overwork, and general stress could affect your pregnancy, may help, too. Explain that being allowed to set your own pace at work may make your pregnancy more comfortable (this kind of stress seems to increase the risk of backaches and other painful pregnancy side effects) and help you do a better job. If you're self-employed, cutting back may be even tougher (you're probably your own most demanding boss), but it's something you'd be wise to consider.

Other work. Teachers and social workers who deal with young children may come into contact with infections that can potentially affect pregnancy, such as chicken pox, fifth disease, and CMV. Animal handlers, meat cutters, and meat inspectors may be exposed to toxoplasmosis (but some may well have developed immunity already, in which case their babies would not be at risk). If you work where infection is a risk, be sure you're immunized as needed and take appropriate precautions, such as washing hands frequently and thoroughly, wearing protective gloves, a mask, and so on. Teachers and social workers who deal with young children may come into contact with infections that can potentially affect pregnancy, such as chicken pox, fifth disease, and CMV. Animal handlers, meat cutters, and meat inspectors may be exposed to toxoplasmosis (but some may well have developed immunity already, in which case their babies would not be at risk). If you work where infection is a risk, be sure you're immunized as needed and take appropriate precautions, such as washing hands frequently and thoroughly, wearing protective gloves, a mask, and so on.

Flight attendants or pilots may be at a slightly higher risk for miscarriage or preterm labor (though studies are inconclusive. due to exposure to radiation from the sun during high-altitude flights, and they might want to consider switching to shorter routes (they're usually flown at lower altitudes and require less standing time) or to ground work during pregnancy.

Artists, photographers, chemists, cosmeticians, dry cleaners, those in the leather industry, agricultural and horticultural workers, and others may be exposed to a variety of possibly hazardous chemicals in the course of work, so be sure to wear gloves and other protective gear. If you work with any suspect substances, take appropriate precautions, which in some cases may mean avoiding the part of the job that involves the use of chemicals.

Staying on the Job Planning to work until that first contraction hits? Many women successfully mix business with baby making right through the ninth month, without compromising the well-being of either occupation. Still, some jobs are better suited to pregnant women during the long haul (so to speak) than other jobs. And chances are, the decision of whether you'll continue to work until delivery will have at least something to do with the kind of work you're involved in. If you have a desk job, you can probably plan to go straight from the office to the birthing room. A sedentary job that isn't particularly stressful may actually be less of a strain on both you and baby than staying at home with a vacuum cleaner and mop, trying to tidy up the nest for your new arrival. And some walking-an hour or two daily, on the job or off-is not only harmless but beneficial (assuming you aren't carrying heavy loads as you go).

Jobs that are strenuous, very stressful, and/or involve a great deal of standing, however, may be another, somewhat controversial, matter. One study found that women who were on their feet 65 hours a week didn't seem to have any more pregnancy complications than women who worked many fewer and usually less stressful hours. Other studies, however, suggest that steady strenuous or stressful activity or long hours of standing after the 28th week-particularly if the expectant mother also has other children to care for at home-may increase the risk of certain complications, including premature labor, high blood pressure, and a low-birthweight baby.

Should women who stand on the job-salespeople, chefs and other restaurant workers, police officers, doctors, nurses, and so on-work past the 28th week? Most practitioners give the green light to work longer if a woman feels fine and her pregnancy is progressing normally. Standing on the job all the way to term, however, may not be a good idea, less because of the theoretical risk to the pregnancy than the real risk that such pregnancy discomforts as backache, varicose veins, and hemorrhoids will be aggravated.

It's probably a good idea to take early leave, if possible, from a job that requires frequent shift changes (which can upset appetite and sleep routines, and worsen fatigue); one that seems to exacerbate any pregnancy problems, such as headache, backache, or fatigue; or one that increases the risk of falls or other accidental injuries. But the bottom line: Every pregnancy, every woman, and every job is different. Together with your practitioner, you can make the decision that's right for your situation.

Changing Jobs With all the changes going on in your life (like your growing belly and the ever-expanding responsibilities that come with it), it may seem counterintuitive to want to add another to your list. But there are dozens of valid reasons why an expectant mom might consider a job change. Maybe your employer isn't family friendly and you're concerned about balancing career and motherhood when you return from maternity leave. Maybe the commute is too long, the hours inflexible, or the grind all-consuming. It could be that you're bored or not fulfilled (and, hey-change is in the air anyway, so why not make the most of it?). Or perhaps you're worried that your current workplace might be hazardous to you and your developing baby. Whatever your reason, here are some things to consider before you make a job move: [image] Looking for work takes time, energy, and focus, three things you may be lacking these days as you concentrate on having a healthy pregnancy. Typically, you'll be asked to come in for several interviews and meetings before an offer is made (and if you're already suffering from pregnancy forgetfulness, forming the kind of sentences that make a good impression may be challenging). Starting a new job also demands a great deal of concentration (all eyes are on you, so you have to be extra careful not to make mistakes), and you should be certain you have the stamina and commitment to take these steps. Looking for work takes time, energy, and focus, three things you may be lacking these days as you concentrate on having a healthy pregnancy. Typically, you'll be asked to come in for several interviews and meetings before an offer is made (and if you're already suffering from pregnancy forgetfulness, forming the kind of sentences that make a good impression may be challenging). Starting a new job also demands a great deal of concentration (all eyes are on you, so you have to be extra careful not to make mistakes), and you should be certain you have the stamina and commitment to take these steps.[image] Before you jump ship, you'll need to be sure the new job you're seeking out is really all it's cracked up to be (in your mind, at least). Does the company you're smitten with offer twice as much vacation time but charge double for health insurance. Do they allow people to work from home yet expect them to be on call morning, noon, and night? Are the salaries far higher and, likewise, the travel demands? Keep in mind that what looks like a great job now may not be so great when you're juggling it with new-baby care (your home life will be a lot more complicated, so you might not want your workplace life to be). Also bear in mind that companies often offer fewer paid short-term disability days or pay a lower percentage of your salary during leave if you have been employed for less than one year. Before you jump ship, you'll need to be sure the new job you're seeking out is really all it's cracked up to be (in your mind, at least). Does the company you're smitten with offer twice as much vacation time but charge double for health insurance. Do they allow people to work from home yet expect them to be on call morning, noon, and night? Are the salaries far higher and, likewise, the travel demands? Keep in mind that what looks like a great job now may not be so great when you're juggling it with new-baby care (your home life will be a lot more complicated, so you might not want your workplace life to be). Also bear in mind that companies often offer fewer paid short-term disability days or pay a lower percentage of your salary during leave if you have been employed for less than one year.[image] By law, your potential employer has no right to ask whether you're pregnant (if it isn't already obvious), nor can he or she deny you an offer in light of the news. Still, some companies simply can't bring you on and let you leave so quickly. And not all employers appreciate what they consider to be a bait-and-switch strategy (you tell them you want to work there, then after you begin, you tell them you'll be out on maternity leave). So though it may be smart in the short run to keep your pregnancy a secret as you interview, it may damage your relationship with the company in the end. On the other hand, sometimes it's better to secure the offer first and then discuss the future once you know the company wants to hire you-but before you accept the position. By law, your potential employer has no right to ask whether you're pregnant (if it isn't already obvious), nor can he or she deny you an offer in light of the news. Still, some companies simply can't bring you on and let you leave so quickly. And not all employers appreciate what they consider to be a bait-and-switch strategy (you tell them you want to work there, then after you begin, you tell them you'll be out on maternity leave). So though it may be smart in the short run to keep your pregnancy a secret as you interview, it may damage your relationship with the company in the end. On the other hand, sometimes it's better to secure the offer first and then discuss the future once you know the company wants to hire you-but before you accept the position.

Unfair Treatment at Work Think you're being treated unfairly on the job because of your pregnancy? Don't just sit there, do something. Let someone you trust-your supervisor, someone in human resources-know how you feel. If that doesn't fix the problem, see if there is a procedure for employees to follow in the case of pregnancy discrimination (you can probably find it in your employee handbook, if there is one). If that still doesn't work, contact the U.S. Equal Employment Opportunity Commission (eeoc.gov) to find your local office. They'll be able to help you determine if you have a legitimate complaint.Remember to keep records of everything that'll bolster your claim (copies of e-mails, letters, a diary of events). This paper trail will also be helpful in case you ever need to contact an attorney.

What if you started a new job before you found out you were pregnant? Be up front about what happened, and then get down to the business of doing your job to the best of your expectant ability. Just make sure you know your rights about job security should the situation take a negative turn.

CHAPTER 9.

The Fourth Month Approximately 14 to 17 Weeks FINALLY, THE BEGINNING OF THE second trimester-which, for many pregnant women, is the most comfortable of the three. And with the arrival of this momentous milestone (one down, two to go!) come some welcome changes. For one, most of the more pesky early pregnancy symptoms may be gradually easing up or even disappearing. That queasy cloud may be lifting (which means that food may actually smell and taste good for the first time in a long time). Your energy level should be picking up (which means you'll finally be able pick yourself up off the sofa), and your visits to the bathroom should be dropping off. And though your breasts will likely still be super-size, they're less likely to be super-tender. Another change for the better: By the end of this month, the bulge in your lower abdomen may be looking less like the remains of a large lunch and more like the beginnings of a pregnant belly. second trimester-which, for many pregnant women, is the most comfortable of the three. And with the arrival of this momentous milestone (one down, two to go!) come some welcome changes. For one, most of the more pesky early pregnancy symptoms may be gradually easing up or even disappearing. That queasy cloud may be lifting (which means that food may actually smell and taste good for the first time in a long time). Your energy level should be picking up (which means you'll finally be able pick yourself up off the sofa), and your visits to the bathroom should be dropping off. And though your breasts will likely still be super-size, they're less likely to be super-tender. Another change for the better: By the end of this month, the bulge in your lower abdomen may be looking less like the remains of a large lunch and more like the beginnings of a pregnant belly.

Your Baby This Month Week 14 Beginning in the second trimester, fetuses (like the children they'll eventually become) start growing at different paces, some faster than others, some more slowly. Despite the differences in growth rates, all babies in utero follow the same developmental path. This week, that path is leading your baby-who is about the size of your clenched fist-toward a straighter position as the neck is getting longer and the head more erect. And on top of that cute little head, your baby might actually be sprouting some hair. Eyebrow hair is also filling in about now, as is body hair, called lanugo. Don't worry, it's not permanent. This downy coating of hair is there to keep your baby warm for now-like a furry blanket. As baby fat accumulates later on in your pregnancy, most of that hair will be shed-though some babies, especially those born early, still have a temporary fuzzy coating at delivery. Beginning in the second trimester, fetuses (like the children they'll eventually become) start growing at different paces, some faster than others, some more slowly. Despite the differences in growth rates, all babies in utero follow the same developmental path. This week, that path is leading your baby-who is about the size of your clenched fist-toward a straighter position as the neck is getting longer and the head more erect. And on top of that cute little head, your baby might actually be sprouting some hair. Eyebrow hair is also filling in about now, as is body hair, called lanugo. Don't worry, it's not permanent. This downy coating of hair is there to keep your baby warm for now-like a furry blanket. As baby fat accumulates later on in your pregnancy, most of that hair will be shed-though some babies, especially those born early, still have a temporary fuzzy coating at delivery.

Your Baby, Month 4 Week 15 Your baby, who measures 4 inches this week and weighs around 2 to 3 ounces, is about the size of a navel orange. Looking more and more like the baby you're picturing in your dreams, his or her ears are positioned properly on the sides of the head (they used to be in the neck), and the eyes are moving from the side of the head to the front of the face. By now your baby has the coordination, strength, and smarts to wiggle his or her fingers and toes and even suck a thumb. But that's not all your baby can do now. He or she can also breathe (or at least make breathing movements), suck, and swallow-all in preparation for the big debut and life outside the womb. And though it's unlikely that you'll be feeling any movements from your little one this week, your baby is certainly getting a workout-kicking, flexing, and moving those arms and legs. Your baby, who measures 4 inches this week and weighs around 2 to 3 ounces, is about the size of a navel orange. Looking more and more like the baby you're picturing in your dreams, his or her ears are positioned properly on the sides of the head (they used to be in the neck), and the eyes are moving from the side of the head to the front of the face. By now your baby has the coordination, strength, and smarts to wiggle his or her fingers and toes and even suck a thumb. But that's not all your baby can do now. He or she can also breathe (or at least make breathing movements), suck, and swallow-all in preparation for the big debut and life outside the womb. And though it's unlikely that you'll be feeling any movements from your little one this week, your baby is certainly getting a workout-kicking, flexing, and moving those arms and legs.

Week 16 With a whopping weight of anywhere from 3 to 5 ounces and a length (crown to rump) of 4 to 5 inches, your baby is growing up fast. Muscles are getting stronger (you'll start to feel movement in a few weeks), especially the back muscles, enabling your little one to straighten out even more. Your baby-to-be is looking more and more adorable, with a face that has eyes (complete with eyebrows and eyelashes) and ears in the right spots. What's more, those eyes are finally working! Yes, it's true: Your baby's eyes are making small side-to-side movements and can even perceive some light, though the eyelids are still sealed. Your baby is also becoming more sensitive to touch. In fact, he or she will even squirm if you poke your belly (though you probably won't be able to feel those squirms just yet). With a whopping weight of anywhere from 3 to 5 ounces and a length (crown to rump) of 4 to 5 inches, your baby is growing up fast. Muscles are getting stronger (you'll start to feel movement in a few weeks), especially the back muscles, enabling your little one to straighten out even more. Your baby-to-be is looking more and more adorable, with a face that has eyes (complete with eyebrows and eyelashes) and ears in the right spots. What's more, those eyes are finally working! Yes, it's true: Your baby's eyes are making small side-to-side movements and can even perceive some light, though the eyelids are still sealed. Your baby is also becoming more sensitive to touch. In fact, he or she will even squirm if you poke your belly (though you probably won't be able to feel those squirms just yet).

Week 17 Take a look at your hand. Your baby is about palm-size now, with a crown-to-rump length of 5 inches and an approximate weight of 5 (or more) ounces. Body fat is beginning to form (baby's fat, that is, though yours is probably forming pretty quickly these days, too), but your little one is still quite skinny, with skin that is practically translucent. This week, your baby is all about practice, practice, practice in preparation for birth. One important skill your baby is sharpening now: sucking and swallowing-to get ready for that first (and second ... and third) suckle at breast or bottle. Your baby's heart rate is regulated by the brain (no more spontaneous beats) and clocks in at 140 to 150 beats per minute (roughly twice your own heart rate). Take a look at your hand. Your baby is about palm-size now, with a crown-to-rump length of 5 inches and an approximate weight of 5 (or more) ounces. Body fat is beginning to form (baby's fat, that is, though yours is probably forming pretty quickly these days, too), but your little one is still quite skinny, with skin that is practically translucent. This week, your baby is all about practice, practice, practice in preparation for birth. One important skill your baby is sharpening now: sucking and swallowing-to get ready for that first (and second ... and third) suckle at breast or bottle. Your baby's heart rate is regulated by the brain (no more spontaneous beats) and clocks in at 140 to 150 beats per minute (roughly twice your own heart rate).

More Baby For week-by-week pics of your baby's amazing development, go to whattoexpect.com.

What You May Be Feeling As always, remember that every woman and every pregnancy is different. You may experience all of these symptoms at one time or another, or only a few of them. Some may have continued from last month; others may be new. Still others may be hardly noticed because you've become so used to them. You may also have other, less common, symptoms. Here's what you might experience this month:

A Look Inside Your uterus, now about the size of a small melon, has grown large enough to rise out of the pelvic cavity and by the end of the month, you'll be able to feel the top of it around 2 inches below your belly button (if you don't know what you're feeling for, ask your practitioner for some pointers at your next visit). If you haven't done so already, you'll probably begin to outgrow your regular clothes.

Physically [image] Fatigue Fatigue[image] Decreasing urinary frequency Decreasing urinary frequency[image] An end to, or a decrease in, nausea and vomiting (for a few women, morning sickness will continue; for a very few, it is just beginning) An end to, or a decrease in, nausea and vomiting (for a few women, morning sickness will continue; for a very few, it is just beginning)[image] Constipation Constipation[image] Heartburn, indigestion, flatulence, bloating Heartburn, indigestion, flatulence, bloating[image] Continued breast enlargement, but usually decreased tenderness Continued breast enlargement, but usually decreased tenderness[image] Occasional headaches Occasional headaches[image] Occasional faintness or dizziness, particularly with sudden change of position Occasional faintness or dizziness, particularly with sudden change of position[image] Nasal congestion and occasional nosebleeds; ear stuffiness Nasal congestion and occasional nosebleeds; ear stuffiness[image] Sensitive gums that may bleed when you brush Sensitive gums that may bleed when you brush[image] Increased appetite Increased appetite[image] Mild swelling of ankles and feet, and occasionally of hands and face Mild swelling of ankles and feet, and occasionally of hands and face[image] Varicose veins of legs and/or hemorrhoids Varicose veins of legs and/or hemorrhoids[image] Slight increase in vaginal discharge Slight increase in vaginal discharge[image] Fetal movement near the end of the month (but usually not this early, unless this is your second or subsequent pregnancy) Fetal movement near the end of the month (but usually not this early, unless this is your second or subsequent pregnancy) Emotionally [image] Mood swings, which may include irritability, irrationality, inexplicable weepiness Mood swings, which may include irritability, irrationality, inexplicable weepiness[image] Excitement and/or apprehension-if you have started to feel and look pregnant at last Excitement and/or apprehension-if you have started to feel and look pregnant at last[image] Frustration at being "in between"-your regular wardrobe doesn't fit anymore, but you're not looking pregnant enough for maternity clothes Frustration at being "in between"-your regular wardrobe doesn't fit anymore, but you're not looking pregnant enough for maternity clothes[image] A feeling you're not quite together-you're scattered, forgetful, drop things, have trouble concentrating A feeling you're not quite together-you're scattered, forgetful, drop things, have trouble concentrating What You Can Expect at This Month's Checkup This month, you can expect your practitioner to check the following, though there may be variations depending on your particular needs and on your practitioner's style of practice: [image] Weight and blood pressure Weight and blood pressure[image] Urine, for sugar and protein Urine, for sugar and protein[image] Fetal heartbeat Fetal heartbeat[image] Size of uterus, by external palpation (feeling from the outside) Size of uterus, by external palpation (feeling from the outside)[image] Height of fundus (top of the uterus) Height of fundus (top of the uterus)[image] Hands and feet for swelling, and legs for varicose veins Hands and feet for swelling, and legs for varicose veins[image] Symptoms you've been experiencing, especially unusual ones Symptoms you've been experiencing, especially unusual ones[image] Questions or problems you want to discuss-have a list ready Questions or problems you want to discuss-have a list ready What You May Be Wondering About Dental Problems "My mouth has suddenly become a disaster area. My gums bleed every time I brush, and I think I have a cavity. Is it safe to have dental work done?"

Smile-you're pregnant! But with so much of your attention centered on your belly during pregnancy, it's easy to overlook your mouth-until it starts screaming for equal time, as frequently happens during pregnancy. For starters, pregnancy hormones aren't kind to your gums-which, like your other mucous membranes, become swollen, inflamed, and tend to bleed easily. Those same hormones also make the gums more susceptible to plaque and bacteria, which can soon make matters worse in some women, possibly leading to gingivitis (inflammation of the gums) and even tooth decay.

To keep your mouth happy-and your smile safe-while you're growing a baby: [image] Floss and brush regularly, and use toothpaste with fluoride for cavity protection. Brushing your tongue while you're at it will also help combat bacteria while keeping your breath fresher. Floss and brush regularly, and use toothpaste with fluoride for cavity protection. Brushing your tongue while you're at it will also help combat bacteria while keeping your breath fresher.[image] Ask your dentist to recommend a rinse to reduce bacteria and plaque, protecting your gums and your teeth. Ask your dentist to recommend a rinse to reduce bacteria and plaque, protecting your gums and your teeth.

A Gum Alert If it's not one thing in pregnancy, it's another. If you notice a nodule on the side of your gum that bleeds when you brush, get it checked out. It's most likely a canker sore or something called a pyogenic granuloma (also known by the ominous-sounding term "pregnancy tumor," despite the fact that it's perfectly harmless). More of a nuisance than anything else, such nodules usually regress on their own after delivery, but if it becomes very annoying before that, it can be removed by a doctor or dentist.

[image]When you can't brush after eating, chew a stick of sugarless gum (the action of chewing increases the amount of saliva, which rinses the teeth-and if the gum's sweetened with xylitol, chewing can actually help prevent decay). Or nibble on a chunk of hard cheese (it decreases the acidity in your mouth, and it's the acid that causes tooth decay).[image] Watch what you eat, particularly between meals. Save sweets (particularly sticky ones) for times when you can brush soon after. Consume plenty of foods high in vitamin C, which strengthens gums, reducing the possibility of bleeding. Also be sure to fill your calcium requirements daily. Calcium is needed throughout life to keep teeth strong and healthy. Watch what you eat, particularly between meals. Save sweets (particularly sticky ones) for times when you can brush soon after. Consume plenty of foods high in vitamin C, which strengthens gums, reducing the possibility of bleeding. Also be sure to fill your calcium requirements daily. Calcium is needed throughout life to keep teeth strong and healthy.

Pearly White Wisdom Wondering if you can use teeth-whitening products while you're pregnant? Check out page 147 page 147 for the latest facts. for the latest facts.

[image]Whether or not you're experiencing dental discomfort, be sure to make an appointment with your dentist at least once during the nine months for a checkup and cleaning, preferably earlier than later. The cleaning is important to remove plaque, which can not only increase the risk of cavities but also make your gum problems worse. If you've had gum problems in the past, also see your periodontist during your pregnancy.

If you suspect a cavity or other tooth or gum trouble, make an appointment with your dentist or periodontist right away. Untreated gingivitis can develop into a more serious gum condition, periodontitis, which has actually been associated with a variety of pregnancy complications. Decay that isn't cleaned up or other tooth issues that aren't tended to can also become a source of infection (and infection isn't good for you or your baby).

What happens if major dental work becomes necessary during pregnancy? Luckily, in most dental procedures, a local anesthetic will suffice, and that's safe. A low dose of nitrous oxide (laughing gas) is also safe to use after the first trimester, but more serious sedation should be avoided during pregnancy. In some cases, it may be necessary to take an antibiotic before or after major dental work; check with your practitioner.

Breathlessness "Sometimes I feel a little breathless. Is this normal?"

Take a deep breath (if you can!) and relax. Mild breathlessness is normal, and many pregnant women experience it beginning in the second trimester. And, once again, you can blame your pregnancy hormones. Here's why: Those hormones stimulate the respiratory center to increase the frequency and depth of your breaths, giving you that out-of-breath feeling after nothing. more strenuous than a trip to the bathroom. They also swell the capillaries in the body-including those of the respiratory tract-and relax the muscles of the lungs and bronchial tubes, making those breaths seem even harder to catch. Your uterus will also likely contribute to your breathlessness as pregnancy progresses, pushing up against your diaphragm as it grows, crowding your lungs and making it more difficult for them to expand fully.

Fortunately, though the mild breathlessness you're experiencing may make you feel uncomfortable, it doesn't affect your baby-who's kept well stocked with oxygen through the placenta. But if you're having a very hard time breathing, if your lips or fingertips seem to be turning bluish, or if you have chest pain and a rapid pulse, call your practitioner right away.

Expecting X-Rays?

Routine dental X-rays (and other routine X-rays or CT scans) are usually postponed until after delivery, just to be on the extra-safe side. But if putting off dental (or other) X-rays during pregnancy just isn't a good idea (the risk of having one is outweighed by the risk of not having one), most practitioners will green-light the procedure. That's because the risks of X-rays during pregnancy are really very low and can be easily made even lower. Dental X-rays are targeted to your mouth, of course, which means the rays are directed far away from your uterus. What's more, a typical diagnostic X-ray of any kind rarely delivers more radiation than you'd get from spending a few days in the sun at the beach. Harm to a fetus, however, only occurs at very high doses, doses you're extremely unlikely to ever be exposed to. Still, if you do need an X-ray during pregnancy, keep the following guidelines in mind: [image] Always inform the doctor ordering the X-ray and the technician performing it that you're pregnant, even if you're pretty sure they know. Always inform the doctor ordering the X-ray and the technician performing it that you're pregnant, even if you're pretty sure they know.[image] Have any necessary X-ray done in a licensed facility with well-trained technicians. Have any necessary X-ray done in a licensed facility with well-trained technicians.[image] The X-ray equipment should, when possible, be directed so that only the minimum area necessary is exposed to radiation. A lead apron should be used to shield your uterus and a thyroid collar should protect your neck. The X-ray equipment should, when possible, be directed so that only the minimum area necessary is exposed to radiation. A lead apron should be used to shield your uterus and a thyroid collar should protect your neck.[image] Follow the technician's directions precisely, being especially careful not to move while he or she is taking the picture, so retakes won't be needed. Follow the technician's directions precisely, being especially careful not to move while he or she is taking the picture, so retakes won't be needed.

Most important, if you had an X-ray before you found out you were pregnant, don't worry.

Nasal Stuffiness and Nosebleeds "My nose has been stuffed up a lot, and sometimes it bleeds for no apparent reason. Is it pregnancy related?"

Your belly's not the only thing that's starting to swell these days. Thanks to the high levels of estrogen and progesterone circulating in your body, which bring with them increased blood flow, the mucous membranes of your nose start to swell, too, and soften (much as the cervix does in preparation for childbirth). Those membranes also produce more mucus than ever, with the intention of keeping infections and germs at bay. What's not so swell is the result-which your nose undoubtedly already knows: congestion, and possibly even nosebleeds. Also not so swell: The stuffiness may only get worse as your pregnancy progresses. You may develop postnasal drip, too, which in turn can occasionally cause coughing or gagging at night (as if you didn't have enough other things keeping you up-or enough gagging going on).

You can safely try saline sprays or nasal strips, especially if the congestion takes a turn for the truly uncomfortable. A humidifier in your room may also help overcome the dryness associated with any congestion. Medications or antihistamine nasal sprays are usually not prescribed during pregnancy, but do ask your practitioner what he or she recommends (some practitioners okay decongestants or steroid nasal sprays after the first trimester).

Taking an extra 250 mg of vitamin C (with your practitioner's okay), plus eating plenty of vitamin Crich foods, may help strengthen your capillaries and reduce the chance of bleeding. Sometimes a nosebleed will follow overly energetic nose blowing, so easy does it.

To stem a nosebleed, sit or stand leaning slightly forward, rather than lying down or leaning backward. Using your thumb and forefinger, pinch the area just above your nostrils and below the bridge of your nose, and hold for five minutes; repeat if the bleeding continues. If the bleeding isn't controlled after three tries, or if the bleeding is frequent and heavy, call your practitioner.

Snoring "My husband tells me that I've been snoring lately. Why is this happening?"

Snoring can disrupt a good night's sleep, for both the snorer and her bedmate, but it's usually not something to lose sleep over when you're expecting. Your nocturnal nasal symphony may simply be triggered by normal pregnancy stuffiness, in which case sleeping with a humidifier (or a nasal strip) on and with your head well elevated may help. Extra weight can also contribute to snoring, so make sure you aren't gaining too much.

Rarely, snoring can signal an elevated risk for gestational diabetes, or a sign of sleep apnea, a condition in which breathing stops briefly during sleep. Since you're breathing for two, it's probably a good idea to mention your snoring to your practitioner at your next visit.

Snooze or Lose?

Are pregnancy hormones-or that growing belly-getting between you and a good night's sleep? Sleep problems are common in pregnancy, and while insomnia may be good preparation for the sleepless nights that lie ahead once your baby arrives, you're likely eager to catch some expectant z's. Before turning to over-the-counter (or prescribed) sleep aids, however, talk to your practitioner. He or she may have other suggestions to help summon the sandman. You can also read the tips on page 265 page 265 to help with your insomnia. to help with your insomnia.

Allergies "My allergies seem to have gotten worse since my pregnancy began. My nose is runny all the time."

Expectant noses are stuffy noses, so it's possible that you're mistaking the normal (though uncomfortable) congestion of pregnancy for allergies. But it's also possible that pregnancy has aggravated your allergies. Though some lucky expectant allergy sufferers (about a third) find a temporary respite from their symptoms during pregnancy, the less lucky (also about a third) find their symptoms get worse, and the rest (that final third) find their symptoms stay about the same. Since it sounds like you're among the less lucky, you're probably itching (and tearing and sneezing) for relief. But before you join the rest of the other allergy sufferers in the antihistamine aisle at the drugstore, check with your practitioner to see what you can safely pull off the shelf or have filled at the pharmacy. Some antihistamines and other medications are safe for use in pregnancy; others, which may or may not include your usual over-the-counter or prescription medication, may not be (though don't worry about any that you took before you knew you were pregnant).

Allergy shots are considered safe for pregnant women who have been on the receiving end of them for a while before they conceived. Most allergists say it's not a good idea to start allergy shots during pregnancy because they may cause unexpected reactions.

In general, however, the best approach to dealing with allergies in pregnancy is prevention-which can be worth a pound of tissues this season. Steering clear of what causes your allergies may also reduce the risk that your baby will develop allergies to those triggers.

No Peanuts for Your Little Peanut?

It's as American as the sandwich bread it's spread on-plus it makes a convenient and wholesome snack-but is peanut butter safe for the little peanut you're feeding in utero? It's long been known that moms (and much less so, dads) who have or have had allergies may pass allergic tendencies-though not necessarily the specific allergies-to their unborn child. Some research suggests that allergic allergic mothers who eat highly allergenic foods (such as peanuts and dairy products) while they're nursing may be more likely to pass on allergies to those foods in their offspring. The good news for expectant peanut butter lovers (and those who like to wash their PB&J down with a glass of milk) is that the research on this connection during pregnancy has been inconclusive thus far. Still, if you have ever suffered from allergies, speak to your practitioner and an allergist about whether you should think about restricting your diet while you're pregnant and/or breastfeeding. If not, there's no need to skip the Skippy. mothers who eat highly allergenic foods (such as peanuts and dairy products) while they're nursing may be more likely to pass on allergies to those foods in their offspring. The good news for expectant peanut butter lovers (and those who like to wash their PB&J down with a glass of milk) is that the research on this connection during pregnancy has been inconclusive thus far. Still, if you have ever suffered from allergies, speak to your practitioner and an allergist about whether you should think about restricting your diet while you're pregnant and/or breastfeeding. If not, there's no need to skip the Skippy.

To ease the sneeze, try these tips: [image] If pollens or other outdoor allergens trouble you, stay indoors in an air-conditioned and air-filtered environment as much as you can during your susceptible season. When you come indoors, wash your hands and face and change clothes to remove pollen. Outdoors, wear large curved sunglasses to keep pollens from floating into your eyes. If pollens or other outdoor allergens trouble you, stay indoors in an air-conditioned and air-filtered environment as much as you can during your susceptible season. When you come indoors, wash your hands and face and change clothes to remove pollen. Outdoors, wear large curved sunglasses to keep pollens from floating into your eyes.[image] If dust is a culprit, make sure someone else does the dusting and sweeping (how's that for a good excuse to get out of housecleaning?). A vacuum cleaner (especially one with a HEPA filter), a damp mop, or a damp cloth-covered broom kicks up less dust than an ordinary broom, and a microfiber cloth will do better than a traditional feather duster. Stay away from musty places like attics and libraries full of old books. If dust is a culprit, make sure someone else does the dusting and sweeping (how's that for a good excuse to get out of housecleaning?). A vacuum cleaner (especially one with a HEPA filter), a damp mop, or a damp cloth-covered broom kicks up less dust than an ordinary broom, and a microfiber cloth will do better than a traditional feather duster. Stay away from musty places like attics and libraries full of old books.[image] If you're allergic to certain foods, stay away from them, even if they're good foods for pregnancy. Check out the Pregnancy Diet (Chapter 5) for substitutes. If you're allergic to certain foods, stay away from them, even if they're good foods for pregnancy. Check out the Pregnancy Diet (Chapter 5) for substitutes.[image] If animals bring on allergy attacks, let friends know of the problem in advance so that they can rid a room of both pets and their dander before you visit. And of course, if your own pet is suddenly triggering an allergic response, try to keep one or more areas in your home (particularly your bedroom) pet free. If animals bring on allergy attacks, let friends know of the problem in advance so that they can rid a room of both pets and their dander before you visit. And of course, if your own pet is suddenly triggering an allergic response, try to keep one or more areas in your home (particularly your bedroom) pet free.[image] Tobacco smoke allergy is easier to control these days, since there are fewer smokers around, and fewer places where they can smoke. To ease your allergy, as well as for the benefit of your baby, avoid exposure to cigarette, pipe, and cigar smoke. Tobacco smoke allergy is easier to control these days, since there are fewer smokers around, and fewer places where they can smoke. To ease your allergy, as well as for the benefit of your baby, avoid exposure to cigarette, pipe, and cigar smoke.

Vaginal Discharge "I've noticed a slight vaginal discharge that's thin and whitish. Does this mean I have an infection?"

A thin, milky, mild-smelling discharge (known in the obstetrics business as leukorrhea) is normal throughout pregnancy. Its purpose is noble: to protect the birth canal from infection and maintain a healthy balance of bacteria in the vagina. Unfortunately, in achieving its noble purpose, leukorrhea can make a mess of your underwear. Because it increases until term and may become quite heavy, some women are more comfortable wearing panty liners during the last months of pregnancy. Don't use tampons, which could introduce unwanted germs into the vagina.

Though it might offend your esthetic sensibilities (and possibly your partner's, during oral sex), and make you feel a little icky and sticky on occasion, this discharge is nothing to worry about. Keeping yourself clean, fresh, and dry will help, of course, but do not douche. Douching upsets the normal balance of microorganisms in the vagina and can lead to bacterial vaginosis (BV; see page 500 page 500). For information on vaginal infection and its symptoms, see page 499 page 499.

Elevated Blood Pressure "My blood pressure was up a little bit at my last visit. Should I be worried?"

Relax. Worrying about your blood pressure will only send the readings higher. Besides, a slight increase at one visit is probably nothing to worry about. Maybe you were stressed because you were caught in traffic on the way to your appointment or because you had a pile of papers to finish back at work. Maybe you were just nervous-you were afraid you'd gained too much weight or not enough, or you had some strange symptoms to report, or you were anxious to hear the baby's heartbeat. Or maybe medical settings just make you edgy, giving you what is known as "white coat hypertension." An hour later, when you were relaxed, your pressure might very well have been perfectly normal. To make sure anxiety doesn't do a number on those numbers again, try to do some relaxation exercises (see page 142 page 142) while you're waiting for your next appointment-and, especially, while your blood pressure's being taken (think happy baby thoughts).

Even if your blood pressure remains slightly elevated at your next reading, such transient high blood pressure (which about 1 to 2 percent of women develop during pregnancy) is perfectly harmless and disappears after delivery (so you can still relax).

Most expectant mothers will see a slight drop in blood pressure readings during the second trimester as blood volume increases and the body starts working long hours to get that baby-making factory up to speed. But when you hit the third trimester, it usually begins to rise a bit. If it rises too much (if systolic pressure-the upper number-is 140 or more or the diastolic pressure-the lower number-is over 90) and stays up for at least two readings, your practitioner will monitor you more closely. That's because if such mildly elevated blood pressure is also accompanied by protein in the urine, swelling of the hands, ankles, and face, and/or sudden weight gain, it may turn out to be preeclampsia; see page 548 page 548.

Sugar in the Urine "At my last office visit, the doctor said that there was sugar in my urine, but that it wasn't anything to worry about. Isn't it a sign of diabetes?"

Take your doctor's advice-don't stress. Your body is probably doing just what it's supposed to do: making sure that fetus of yours, which depends on you for its fuel supply, is getting enough glucose (sugar).

The hormone insulin regulates the level of glucose in your blood and ensures that enough is taken in by your body cells for nourishment. Pregnancy triggers anti-insulin mechanisms to make sure enough sugar remains circulating in your bloodstream to nourish your fetus. It's a perfect idea that doesn't always work perfectly. Sometimes the anti-insulin effect is so strong that it leaves more than enough sugar in the blood to meet the needs of both mother and child-more than can be handled by the kidneys. The excess is "spilled" into the urine. Thus "sugar in the urine" is not uncommon in pregnancy, especially in the second trimester, when the anti-insulin effect increases. In fact, roughly half of all pregnant women show some sugar in the urine at some point in their pregnancies.

Get Your Flu Shots The Centers for Disease Control and Prevention recommends that every woman who will be pregnant during flu season (generally October through April) be given the flu shot. The shot will not affect your baby and is unlikely to cause you any side effects. (The worst that can happen is you'll develop a mild fever and feel more tired than usual for a few days.) Ask if you can get the thimerosal-free (or reduced) vaccine, if available. Pregnant women should not get FluMist, the nasal spray flu vaccine. FluMist, unlike the flu shot, is made from live flu virus and could actually give you a mild case of the flu.

In most women, the body responds to an increase in blood sugar with an increased production of insulin, which usually eliminates the excess sugar by the next office visit. This may well be the case with you. But some women, especially those who are diabetic or have tendencies toward diabetes (because of a family history or because of their age or weight), may be unable to produce enough insulin at one time to handle the increase in blood sugar, or they may be unable to use the insulin they do produce efficiently. Either way, these women continue to show high levels of sugar in both blood and urine. In those who were not previously diabetic, this is known as gestational diabetes (see page 546 page 546).

You-like every pregnant woman-will be given a glucose screening test around the 28th week to check for gestational diabetes (those at higher risk may be screened earlier). Until then, don't give the sugar in your urine another thought.

Anemia "A friend of mine became anemic during pregnancy-is that common?"

Iron-deficiency anemia is common during pregnancy-but it's also incredibly easy to prevent. And when it comes to prevention, your practitioner has your back. You were already tested for anemia at your first prenatal visit, though it's unlikely you were low on iron then. That's because iron stores are quickly replenished once those monthly periods stop.

As your pregnancy progresses and you hit the halfway mark (around 20 weeks, coming right up), your blood volume expands significantly and the amount of iron needed for producing red blood cells dramatically increases, depleting those stores once again. Fortunately, filling those stores up again-and effectively preventing anemia-is as easy as taking a daily iron supplement (in addition to your prenatal vitamin), which your practitioner may prescribe starting midway through pregnancy. You should also pump up your diet by eating foods loaded with iron (though dietary sources, such as the ones listed on page 100 page 100, may not do the job alone, they provide a great backup for your supplement). For extra absorption, chase your iron down with vitamin Crich foods (your morning OJ instead of your morning java, which will actually reduce the amount of iron absorbed).

Symptoms of Anemia Pregnant women with mild iron deficiency rarely have symptoms. But as oxygen-carrying red blood cells are further depleted, an anemic mother-to-be becomes pale, extremely weak, easily tired or breathless, and might even experience fainting spells. This may be one of the few instances where fetal nutritional needs are met before Mom's, since babies are rarely iron deficient at birth.

Though all pregnant women are susceptible to iron-deficiency anemia, certain groups are at particularly high risk: those who have had several babies in quick succession, those who have been vomiting a lot or eating little because of morning sickness, and those who came to pregnancy undernourished (possibly because of an eating disorder) and/or have been eating poorly since they conceived. Daily iron supplementation, as prescribed by your practitioner, should prevent (or relieve) anemia.

Fetal Movement "I haven't felt the baby moving yet; could something be wrong? Or could I just not be recognizing the kicking?"

Forget that positive pregnancy test, the early ultrasound, that expanding belly, or even the lub-dub of a baby's heartbeat. Nothing says you're pregnant like fetal movement.